Community dental health coordinator cdhc
Download
1 / 36

Community Dental Health Coordinator CDHC - PowerPoint PPT Presentation


  • 773 Views
  • Updated On :

Community Dental Health Coordinator (CDHC). Amid I. Ismail Chair, American Dental Association CDHC Curriculum Committee Jane Grover Director, Center for Family Health, Jackson, MI December 12, 2007 National Network for Oral Health Access (NNOHA) San Diego, CA. Outline.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Community Dental Health Coordinator CDHC' - Sophia


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

Slide2 l.jpg

Amid I. Ismail

Chair, American Dental Association CDHC Curriculum Committee

Jane Grover

Director, Center for Family Health, Jackson, MI

December 12, 2007

National Network for Oral Health Access (NNOHA)

San Diego, CA


Outline l.jpg
Outline

  • Definition of the CDHC?

  • Frameworks for increasing access and reducing oral health disparities

  • Current status of the CDHC project

  • Perspective of a FQHC dental director

  • Outcomes and evaluation


Definition of the cdhc l.jpg
Definition of the CDHC

Community health worker (CHWs) with

DENTAL SKILLS


Definition of community health workers l.jpg
Definition of Community Health Workers

  • CHWs are community members who are

    • Trained to promote health, provide leadership, peer education, and resources to support community empowerment.

    • Trained to integrate information about health and the health care system into the community’s culture, language, and value system, thus reducing many of the barriers to health services.


Chws functions of the cdhc l.jpg
CHWs Functions of the CDHC

  • Coordinate and navigate dental care

  • Advocate for individuals

  • Motivate and assist people to prevent dental and oral diseases

  • Educate community groups and individuals


Chws functions of the cdhc7 l.jpg
CHWs Functions of the CDHC

  • Assist community members to enroll in Medicaid or other programs

  • Assist in reducing dental anxiety and fatalism

  • Provide social support and self-efficacy

  • Advocate for oral health

  • Advocate for the CHCs


Dental skills of the cdhc l.jpg
Dental Skills of the CDHC

  • Screen for dental emergency and need for urgent care

  • Take of digital radiographs

  • Use an interactive online database to share information with the supervising dentist

  • Triage care based on disease and risk status


Dental skills of the cdhc9 l.jpg
Dental Skills of the CDHC

  • Per the instructions of the supervising dentist, provide the following preventive procedures

    • Oral hygiene assessment and education

    • Gross scaling

    • Temporary GIC restorations

    • Topical fluorides

    • Sealants


Supervision of the cdhc l.jpg
Supervision of the CDHC

  • The CDHC will be a salaried employee of a community health center

  • They may also be hired by dental providers who serve low-income or rural communities

  • Geographic zones of practice will be determined state-by-state based on dental workforce shortages and disease levels


Frameworks l.jpg

Frameworks

The CDHC model is based on extensive experience with CHWs and expanded function dental auxiliaries


Effectiveness chws l.jpg
Effectiveness: CHWs

  • Improved outcomes for

    • prenatal care,

    • cancer screening,

    • child sick visits,

    • immunizations for children,

    • chronic illness care,

    • maternal health,

    • STD testing,

    • smoking cessation, and

    • mental health and outreach services.


Effectiveness of chws l.jpg
Effectiveness of CHWs

  • Promoted weight loss and breastfeeding among African Americans

  • Reduced drug use

  • Increased condom use among homeless women,

  • Increased physical activity among African-American women with type II diabetes

  • Reduced missed appointments

  • Increased follow-up care.


What about capacity l.jpg
What about capacity?

  • Triage patients based on their dental needs

  • Prevention in the community

  • Follow-up preventive and motivational interventions

    • Reduce missed appointments

    • Increase utilization

  • Increase revenues for the FQHC

    • Hire staff

  • Community health worker functions may become reimbursable in the near future


Net balance l.jpg
Net Balance

To cover all cost in year one, the CDHC (HS graduate) must recruit around 550 patients or 2 patients per work day.


Trainees l.jpg
Trainees

  • DHs may be trained and certified as CDHCs

  • DAs may be trained and certified as CDHCs

  • High school graduates will enroll in a 12-month program

  • All trainees must work as interns at a FQHC or CHC for 6 months



Site selected for demonstration projects l.jpg
Site Selected For Demonstration Projects

  • Michigan

    • Site director Amid Ismail, University of Michigan

    • Urban site in FQHCs

  • Oklahoma

    • Site director Dunn Cumby, University of Oklahoma

    • Rural site which may include some Native American clinics

  • Native American Locations

    • Site directors Nancy Reifel and Donna Kotyk, UCLA

    • Using multiple sites (MT, SD, MN, and other states)

  • ADA House of Delegates allocated $2 Million to cover the cost of the demonstration projects with local funding sources.


Curriculum l.jpg
Curriculum

  • First draft to be completed this December

  • 14 Modules

  • First 6 focus on CHW certification

  • 7 on dental skills (screening, radiographs, prevention of caries, periodontal disease, oral cancer)

  • 1 internship

  • Unique modules: motivational interviewing; detailed oral hygiene assessment using the Nexo Method; oral cancer screening; tobacco cessation


Slide21 l.jpg


Slide22 l.jpg

Moving Forward Requires New Models that Promote Community-based and Individual-focused Changes in Social, Organizational, and Behavioral DeterminantsIntegrated Dental Care and Oral Health Promotion Model


Fqhc dental director dr jane grover l.jpg
FQHC dental director Community-based and Individual-focused Changes in Social, Organizational, and Behavioral DeterminantsDr. Jane Grover

  • The CDHC is at the door

    • What can they do?

    • Sites

    • Equipment

    • Supervision

    • Training of clinical and other FQHC staff

    • Benefits to my clinic

    • Costs and risks

    • Outcomes


Slide24 l.jpg

Population: 140,267 (2000) Community-based and Individual-focused Changes in Social, Organizational, and Behavioral Determinants

Race: 88.7 Whites, 7.9 Blacks

0-19 years: 45,000

Medicaid: 14.0% (2000)

Medicaid: 16.2% (2006)

Dentists: 77 (2000)

Dental Hygienists: 117 (2000)

Preventive visits: 48.5%

FQHC: 1 (3 sites)

Dentists: 3.5 FTE

DHs: 4

DA: 7

Patients/year: 8,500


Dental skills cdhc l.jpg
Dental Skills Community-based and Individual-focused Changes in Social, Organizational, and Behavioral DeterminantsCDHC

  • Screen for emergency dental needs using questionnaires and visual inspections

  • Immediate scheduling

    • We will see them when we find them

  • Screen for signs of caries, periodontal disease, and oral cancer

  • Take radiographs

    • Enter all data in the CDHC database

  • Triage patients based on urgency

  • Assess and improve oral hygiene practices

  • Map location of plaque in stagnation areas

  • Write oral hygiene goals card

  • Demonstrate how to remove plaque from stagnation areas


Dental skills cdhc26 l.jpg
Dental Skills Community-based and Individual-focused Changes in Social, Organizational, and Behavioral DeterminantsCDHC

  • Apply topical fluorides

  • Place sealants

  • Temporize cavities to remove foci of infection prior to application of fluorides and sealants

  • Risk-based preventive recall


Cdhc chw skills l.jpg
CDHC Community-based and Individual-focused Changes in Social, Organizational, and Behavioral DeterminantsCHW skills

  • What can they do?

    • Navigate dental care and referral

    • Dental anxiety

    • Oral health literacy

    • Nutritional literacy

    • Personal preventive plans

    • Pregnant women

    • Infant oral health

    • Education of caregivers (parents)

    • Oral cancer patients

    • Tobacco cessation

    • Coordination with medical providers


Coordination of dental care l.jpg
Coordination of Dental Care Community-based and Individual-focused Changes in Social, Organizational, and Behavioral Determinants

  • Missed appointments

  • First contact in the community

  • Group education

  • Advocate on behalf of community members

  • Advocate on my behalf with community members

  • Follow-up with patients who need referral or follow-up care


Slide29 l.jpg

  • Potential assignment sites Community-based and Individual-focused Changes in Social, Organizational, and Behavioral Determinants

    • Schools

    • WIC/Head Start

    • Neighborhoods

    • Nursing homes

    • Waiting rooms of medical clinics

    • Emergency rooms in hospitals

    • Triage the waiting list for dental care


Equipment l.jpg
Equipment Community-based and Individual-focused Changes in Social, Organizational, and Behavioral Determinants

  • Portable dental chair and light

  • Sealant unit (compressor, electric handpiece, air syringe, saliva ejector, high speed suction)

  • Nomad

  • PC with wireless card

  • Cell phone

  • Instruments

    • Mirror

    • PSR probe

    • Cotton pliers

    • Intra-oral light

    • Temporary restoration kits

  • Sundries

  • Autoclave (Statim)

  • Car (personal or FQHC owned)

  • Insurance


Remote supervision l.jpg
Remote Supervision Community-based and Individual-focused Changes in Social, Organizational, and Behavioral Determinants


Training of staff who work with cdhc l.jpg
Training of staff who work with CDHC Community-based and Individual-focused Changes in Social, Organizational, and Behavioral Determinants

  • Front desk staff who can schedule appropriately

  • Dental hygienists: Coordination between hygienists and the CDHCs to prioritize schedules based upon needs of patients

  • Dentists who will review screening records and questionnaires recorded by the CDHC to triage care and develop a management plan for the CDHC

  • Other FQHC providers who will benefit from working with the CDHCs (prenatal care, pre-term, diabetes, smokers)

  • Community outreach coordinators at the FQHC


Potential benefits l.jpg
Potential Benefits Community-based and Individual-focused Changes in Social, Organizational, and Behavioral Determinants

  • Integrated dental care model

  • Risk-based preventive care at home or community

  • Increased productivity

  • Advocate for FQHC services in the community

  • Disseminate accurate information regarding locations, staff and hours of operation


Risks l.jpg
Risks Community-based and Individual-focused Changes in Social, Organizational, and Behavioral Determinants

  • Remote supervision

  • Quality of care

  • Capacity to meet increased demand for dental care

  • Turnover and cost of re-training

  • Uncompensated care


Outcomes l.jpg
Outcomes Community-based and Individual-focused Changes in Social, Organizational, and Behavioral Determinants

  • Access to dental care

  • Efficiency of operations (increase quantity and quality)

  • Reduction of severe disease

  • Prevention of early disease

  • Patient satisfaction and quality of life

  • Networks with community and professional organizations


To move forward oral health promotion prevention within an integrated dental care model l.jpg
To move forward Community-based and Individual-focused Changes in Social, Organizational, and Behavioral DeterminantsOral health Promotion, Prevention, within an Integrated Dental Care Model

  • Three demonstration projects in 2008-09

  • Focus on

    • Integrated care

    • Oral health promotion

    • Disease prevention

    • Social and behavioral determinants


ad